Atherosclerotic renovascular disease (ARVD) is more commonly identified than ever before, particularly among the elderly population. By some accounts, >10% of new patients entering dialysis programs in the United States have ARVD as a major contributor to their end-stage renal disease. ARVD is also associated with accelerated renal injury, hypertension, and cardiovascular complications. Renovascular hypertension (RVH) is an independent cardiovascular risk factor and induces greater decline in cardiac function and structure than essential hypertension.1 However, clinical trials show consistently that revascularization of the stenotic renal artery using percutaneous transluminal renal angioplasty (PTRA) results in limited and inconsistent recovery of renal function.2 The reasons for the failure of revascularization to resolve renal dysfunction are complex and may include procedural complications, as well as pre-existing parenchymal injury, including endothelial dysfunction, inflammation, fibrosis, and microvascular remodeling in the poststenotic kidney.3 Atherogenic comorbidities constitute important catalysts of renal damage in ARVD. In fact, atherosclerotic nephropathy can produce renal damage even with hemodynamically insignificant stenoses,4 suggesting a direct effect of atherosclerosis on the kidney. Furthermore, unlike patients with fibromuscular dysplasia, in patients with ARVD a decrease in stenotic-kidney perfusion does not correlate with the angiographic degree of stenosis,5 and cortical perfusion is reduced even with mild stenoses, underscoring the contribution of additional pathogenic factors to renal damage. Therefore, the quest for underlying mechanisms and promising interventions mandates development of experimental platforms that not only involve renal artery stenosis but also emulate the atherosclerotic milieu. Useful models of renal artery stenosis have been achieved in many laboratory animal species, including mice, rats, hamsters, rabbits, dogs, and monkeys, but usually without application of comorbidities.6 Our studies focused on developing a swine model with gradually developing renal artery stenosis secondary to unilateral renal arterial implantation of a local irritant coil. The advantages …